Abstract
Hip osteoarthritis (OA) is an important public health issue. Nonsurgical treatments including changes in lifestyle, physiotherapy, pharmacological therapy can be effective for patients with coxalgia at early stages of hip osteoarthritis. Objective To evaluate the effectiveness of percutaneous radiofrequency (RF) denervation (neuroablation) of articular sensory nerves of the hip joint for pain relief in patients with chronic hip pain. Material and methods The review included 46 patients (47 joints) with hip OA who were classified as Kellgren-Lawrence grade 3 (n = 37) and Kellgren-Lawrence grade 4 (n = 9). Quantitative and qualitative assessment of pain was produced with VAS scale. The Harris Hip Score (HHS) was used to measure functionality. All patients underwent radiofrequency ablation of the articular branches of the femoral and obturator nerves. The results of treatment were evaluated at 2 weeks, 1, 3, 6 and 12 months. Results VAS scores showed significant pain relief immediately after the procedure that persisted in 69.5 % of patients at 6 months and in 56.5 % at 12 months with 43.5% of patients reporting dissatisfaction. HHS scores demonstrated improved quality of life in 85.2 % of patients at 6 months, with patient satisfaction recorded in 58.6 % at 12 months, and 41.3 % reported significant deterioration. Conclusions Percutaneous RF denervation of articular sensory nerves of the hip joint was shown to be effective for pain relief in patients with severe hip OA at a short term (up to 6 months). The technique can be recommended for patients who have contraindications to hip replacement surgery.
Highlights
Osteoarthritis (OA) is the most common type of joint disease and one of the most common orthopaedic issues, with musculoskeletal conditions being a leading cause of burden of disease [1–3]
Clinical manifestations of OA can be seen at the age of 35–40 years with the incidence of osteoarthritis in the population increasing annually and ranging from 10 to 23 % [4–7]
Percutaneous radiofrequency (RF) denervation of articular sensory nerves of the hip joint can be effectively used for pain relief in patients with chronic hip pain [12– 15]
Summary
Osteoarthritis (OA) is the most common type of joint disease and one of the most common orthopaedic issues, with musculoskeletal conditions being a leading cause of burden of disease [1–3]. OA is considered a disease of the whole joint, including alterations in the articular cartilage, subchondral bone, synovial membrane, ligaments, capsule and periarticular muscles [2–4]. Pathological changes observed in OA include degradation of articular cartilage, subchondral bone thickening, osteophytes synovial inflammation, damage to the ligaments and joint capsule, which progress over time, leading to chronic pain, stiffness, deformity and limited physical function. Percutaneous radiofrequency (RF) denervation (neuroablation) of articular sensory nerves of the hip joint can be effectively used for pain relief in patients with chronic hip pain [12– 15]. Targeted thermal action on the nerve fibers leads to the inhibition of the conduction of pain impulses. Pain conduction blocks after RF denervation are reported to last up to three years and over, with physical activity being pain free in the involved joint [11–16]
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